Orange County NC Website
Browse       Search
POLICY CHANGE DOCUMENT <br />POLICY NO: <br />PHPK1750468-000 <br />CHANGE #3 CHANGE EFFECTIVE:09/24/2018 <br />Page 1 of 1 <br />Philadelphia Indemnity Insurance CompanyPRODUCER:THEINSURANCECENTEROF <br />DURHAM <br />NAMED INSURED:JW Athletics Foundation <br />MAILING ADDRESS2621 Brookhollow Rd <br />Efland,NC27216- <br />POLICY PERIOD:FROM12/11/2017TO12/11/2018at <br />12:01 A.M. Standard Time at your mailing address shown above. <br />DESCRIPTION: <br />In consideration of the premium reflected, the policy is amended as indicated below: <br />Added 1 Additional Insured. <br />Total Annual <br />Additional/Return Premium$0.00 <br />Total Prorate <br />Additional/Return Premium$0.00 <br />Total Annual <br />Additional/Return <br />Tax/Surcharge/Fee$0.00 <br />Total Prorate <br />Additional/Return <br />Tax/Surcharge/Fee$0.00 <br />DocuSign Envelope ID: E569A9F5-CEAA-4900-97A7-43153531A654